Increased platelet inhibition after switching from prasugrel to low-dose ticagrelor in Japanese patients with prior myocardial infarction

Tateishi, Kazuya; Saito, Yuichi; Kitahara, Hideki; Nakayama, Takashi; Fujimoto, Yoshihide; Kobayashi, Yoshio

doi:10.1016/j.jjcc.2019.10.004

Cited by 8 publications

(4 citation statements)

References 39 publications

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“…In this scenario, ticagrelor may be an alternative to avoid HPR. We and others have reported that ticagrelor provided more potent platelet inhibition than prasugrel 29,30) . In our previous report, PRU values were significantly lower in patients treated with 60 mg of ticagrelor twice daily than those treated with 3.5 mg of prasugrel once daily, and no patients had HPR on ticagrelor in Japanese patients with prior myocardial infarction 30) .…”

Section: Disclosuresmentioning

confidence: 68%

“…We and others have reported that ticagrelor provided more potent platelet inhibition than prasugrel 29,30) . In our previous report, PRU values were significantly lower in patients treated with 60 mg of ticagrelor twice daily than those treated with 3.5 mg of prasugrel once daily, and no patients had HPR on ticagrelor in Japanese patients with prior myocardial infarction 30) . Although antithrombotic therapy was used to mitigate thrombotic risks, their use must be balanced against bleeding complications; potent antiplatelet therapy under a risk score guidance presumably has a potential to improve clinical outcomes.…”

Section: Disclosuresmentioning

confidence: 68%

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Derivation of a Novel Scoring System Predicting High Platelet Reactivity on Prasugrel in Patients with Coronary Artery Disease

Saito

Nishi

Wakabayashi

et al. 2022

JAT

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High platelet reactivity (HPR) has been associated with an increased risk of thrombotic events in patients undergoing percutaneous coronary intervention. HPR has been well examined in patients treated with clopidogrel; however, HPR on prasugrel is poorly investigated.Methods: Four prospective studies were pooled, in which platelet reactivity on prasugrel was measured using VerifyNow assay; genotyping of CYP2C19 was also performed. Factors associated with HPR on prasugrel were identified using multivariable analysis to develop a risk prediction model. Results:In total, 180 patients were examined in this study, of whom 51 (28%) had HPR on prasugrel. The multivariable analysis indicated that hypertension, diabetes, hemodialysis, and the number of CYP2C19 loss-offunction (LOF) alleles are significant factors for HPR on prasugrel. These four factors were then incorporated to develop the HHD-GENE score. The receiver operating characteristic curve analysis showed that the HHD-GENE score predicted HPR on prasugrel (area under the curve (AUC) 0.74, best cutoff value 5, p＜0.001). With the best cutoff value, patients with the HHD-GENE score ≥ 5 had a significantly increased risk of HPR on prasugrel than their counterpart (50% vs. 18%, p＜0.001). Conclusions:The HHD-GENE score consisting of hypertension, diabetes, hemodialysis, and CYP2C19 LOF alleles may be useful in identifying patients on prasugrel who are at high risk for HPR. External validation is needed to define the clinical utility of this novel scoring system.broadly used P2Y12 inhibitor in PCI, whereas prasugrel and ticagrelor are the newer guidelinerecommended agents in patients with ACS 1) . According to the randomized ISAR-REACT 5 trial results 4) , the recent European guidelines recommend prasugrel in preference to ticagrelor for patients with non-ST segment elevation ACS 5) .Inadequate platelet inhibition, namely high platelet reactivity (HPR), has been identified as a predictor of thrombotic events, such as cardiovascular

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Section: Disclosuresmentioning

confidence: 68%

Section: Disclosuresmentioning

confidence: 68%

Derivation of a Novel Scoring System Predicting High Platelet Reactivity on Prasugrel in Patients with Coronary Artery Disease

Saito

Nishi

Wakabayashi

et al. 2022

JAT

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“…We excluded the TROPICAL-ACS trial because of short DAPT treatment for 7 days, which didn’t match the inclusion criteria of the potent DAPT treatment for the acute phase of ACS should be at least 1 month [ 33 ]. Several studies suggested there might be larger response variability and high platelet reactivity after DAPT de-escalation from a potent P2Y12 inhibitor to clopidogrel, due to the peculiar bio-transfer process of the prodrug of clopidogrel [ 34 , 35 ]. Hence, the TROPICAL-ACS trial aimed to investigate the effects of DAPT de-escalation from prasugrel to clopidogrel guided by platelet function testing, and the results suggested the DAPT de-escalation guided by genetic or platelet function testing was non-inferior to standard DAPT based on prasugrel [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

De-Escalation Dual Antiplatelet Therapy Prevail over Potent P2Y12 Inhibitor Monotherapy in Patients with Acute Coronary Syndrome Undergone Percutaneous Coronary Intervention: A Network Meta-Analysis

Ding¹,

Chen²,

Yu³

et al. 2022

Rev. Cardiovasc. Med.

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Background: Dual antiplatelet therapy (DAPT) with potent P2Y12 inhibitor is the cornerstone of acute coronary syndrome (ACS) management. Balancing the effects of different strategies of antiplatelet therapy including DAPT de-escalation, potent P2Y12 inhibitor monotherapy, and conventional DAPT is a hot topic. Methods: A systematic search was conducted from the MEDLINE, PubMed, and Embase through October 2021 to identify various DAPT strategies in randomized controlled trials (RCTs) for treatment of ACS patients after undergoing PCI with drug-eluting stent (DES). The network meta-analysis was performed to investigate the net clinic benefit of the DAPT de-escalation, potent P2Y12 inhibitor monotherapy, as well as conventional DAPT. The primary outcome was net adverse clinical events, defined as a composite of major bleeding and cardiac death, myocardial infarction, stroke, stent thrombosis, or target-vessel revascularization. The secondary outcomes include major adverse cardiac events and trial-defined major or minor bleeding. Results: A total of 14 RCTs with 63,982 patients were included. The DAPT de-escalation was associated with a lower risk of the primary outcome compared with potent P2Y12 inhibitor monotherapy (De-escalation vs monotherapy odds ratio (OR): 0.72 95% confidence interval (CI): 0.55-0.96), and other antiplatelet strategies (De-escalation vs clopidogrel + aspirin OR: 0.49 95% CI: 0.39-0.63; De-escalation vs prasugrel + aspirin OR: 0.76 95% CI: 0.59-0.98; De-escalation vs ticagrelor + aspirin OR: 0.76 95% CI: 0.55-0.90). There were no statistical differences in the incidence of bleeding (DAPT de-escalation vs P2Y12 inhibitor monotherapy OR: 0.73 95% CI: 0.47-1.12) and major adverse cardiac events (DAPT de-escalation vs P2Y12 inhibitor monotherapy OR: 0.79 95% CI: 0.59-1.08) between DAPT de-escalation and potent P2Y12 inhibitor monotherapy. Conclusions: This network meta-analysis showed that DAPT de-escalation would reduce the net adverse clinical events, compared with potent P2Y12 inhibitor monotherapy, for ACS patients undergone PCI treatment.

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“…Ticagrelor is a new adenosine diphosphate receptor antagonist providing prompter and more potent platelet inhibition than clopidogrel, and it is less susceptible to CYP2C19 polymorphisms [ 10 , 37 , 47 , 48 ]. Because ticagrelor itself is an active antiplatelet agent, it does not require an activation process, unlike clopidogrel and prasugrel.…”

Section: Optimal Antithrombotic Regimen In East Asian Patients Witmentioning

confidence: 99%

Antithrombotic Strategy for Patients with Acute Coronary Syndrome: A Perspective from East Asia

Numasawa

Sawano

Fukuoka

et al. 2020

JCM

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Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention has become the standard of care, particularly in patients with acute coronary syndrome (ACS). Current clinical guidelines recommend novel P2Y12 inhibitors (e.g., prasugrel or ticagrelor) in addition to aspirin based on the results of representative randomized controlled trials conducted predominantly in Western countries. These agents were superior to clopidogrel in reducing the composite ischemic events, with a trade-off of the increased bleeding events. However, multiple differences exist between East Asian and Western patients, especially with respect to their physique, thrombogenicity, hemorrhagic diathesis, and on-treatment platelet reactivity. Recent studies from East Asian countries (e.g., Japan or South Korea) have consistently demonstrated that use of novel P2Y12 inhibitors is associated with a higher risk of bleeding events than use of clopidogrel, despite borderline statistical difference in the incidence of composite ischemic events. Additionally, multiple studies have shown that the optimal duration of DAPT may be shorter in East Asian than Western patients. This review summarizes clinical studies of antithrombotic strategies in East Asian patients with ACS. Understanding these differences in antithrombotic strategies including DAPT and their impacts on clinical outcomes will aid in selection of the optimal tailored antithrombotic therapy for patients with ACS.

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Increased platelet inhibition after switching from prasugrel to low-dose ticagrelor in Japanese patients with prior myocardial infarction

Cited by 8 publications

References 39 publications

Derivation of a Novel Scoring System Predicting High Platelet Reactivity on Prasugrel in Patients with Coronary Artery Disease

Derivation of a Novel Scoring System Predicting High Platelet Reactivity on Prasugrel in Patients with Coronary Artery Disease

De-Escalation Dual Antiplatelet Therapy Prevail over Potent P2Y12 Inhibitor Monotherapy in Patients with Acute Coronary Syndrome Undergone Percutaneous Coronary Intervention: A Network Meta-Analysis

Antithrombotic Strategy for Patients with Acute Coronary Syndrome: A Perspective from East Asia

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